AYO BT+ Uses Cases for Elite Athletes

by admin | Nov 4, 2022 | Diaphragmatic Breathing

About AYO BT+

AYO BT+ is the world’s first modular measurement respirator for breathing retraining. It fills a significant gap that, before its release, no such device could provide breathing data while people were performing sports and fitness training.

The possible applications with AYO BT+ are extensive, and in this document, we focus on its use cases for elite athletes.

Train for Diaphragmatic Breathing

Diaphragmatic breathing via the nose is widely recognised as the most efficient, surpassing other techniques like chest breathing through the mouth. However, many elite athletes rely on chest breathing during their sports activities, unknowingly limiting their potential for superior performance, particularly in endurance-based sports that demand exceptional aerobic capabilities.

Enter AYO BT+: the ultimate tool for training diaphragmatic breathing and unlocking the true potential of elite athletes. This innovative device combines the AYO BT with measurement modules, offering a comprehensive solution for optimising breathing techniques.

The AYO BT+ utilises a unique mechanism to enhance diaphragmatic breathing. Controlling the air inlet and adding resistance effectively slows down and elongates the inhalation process, activating the diaphragm, the primary muscle responsible for efficient breathing.

Transitioning from chest to diaphragmatic breathing can be challenging, especially for athletes who have relied exclusively on chest breathing throughout their careers. However, with consistent use of AYO BT+ over time, athletes can train their bodies to naturally engage the diaphragm, laying a solid foundation for reaching new heights in their respective sports.

By incorporating AYO BT+ into their training routine, elite athletes can experience many benefits. Improved diaphragmatic breathing enhances oxygen intake, endurance, stamina, and overall aerobic capacity. This technique also promotes better relaxation, reducing muscle tension and facilitating quicker recovery between workouts or events.

Measure the Loading to the Breathing Muscles

Most resistance-based training masks provide adjustable air inlet resistance to load the breathing muscles. However, the accurate resistance loading varies with the actual breathing effort. For example, even if a small inlet setting is selected, the resistance may only be high enough if the athlete puts on enough effort.

This is where AYO BT+ can come in, where it measures the Power of Breath cycle by cycle and the Work of Breath for the entire training session. The highly repeatable data provides more accurate loading metrics that a coach would prescribe than just a gut feeling that may vary and not be reliable.

Train for Breathing Efficiency

The flip side of Power of Breath and Work of Breath can be used to assess breathing efficiency. For example, for running the same distance with similar intensity, if the Power of Breath and Work of Breath is lower than before, it would indicate that breathing efficiency is improved.

Gain More Insights into the Effectiveness of Training Programs

Apart from going to a sports test lab, the physiological data that can be conveniently and accurately measured is limited to heart rate only. This is surprising, given the advances in general technology in the past 50 years.

We know that, technically, the heart rate indicates how fast the heart is pumping blood.

The key reason to measure heart rate in sports training is to assess:

The fitness level of an athlete
The loading of the training to the athlete
The recovery of the athlete

However, the blood is primarily used to transport oxygen to the body tissues and cells, where the oxygen reacts with carbohydrates and fats to produce the energy the body needs during cellular respiration. Yet, as part of the process, the oxygen needs to enter the bloodstream in the first place via gas exchange during breathing, and then before the oxygen reaches the tissues, it needs to be released from the red blood cells.

How the air is breathed in and out may affect the gas exchange and the release of oxygen from the blood to the tissues so that the oxygen may not diffuse from the lung into the blood efficiently. Once in the blood, it may not be efficiently used.

Understanding the oxygen delivery process to tissues and cells reveals that the heart’s role in pumping blood is just one step in the overall mechanism. It is crucial to recognise how oxygen enters the bloodstream and is released to the tissues to obtain a comprehensive understanding. Relying solely on heart rate for assessing athlete fitness or training program effectiveness is insufficient and may lead to inaccurate conclusions.

For instance, a higher-than-normal heart rate does not necessarily indicate intense training or low fitness levels. It could result from hyperventilation, which prevents oxygen from effectively reaching the tissues and cells, despite the increased heart rate.

The Bohr Effect, a scientific principle, influences efficient oxygen transportation in the blood. Hyperventilation leads to lower levels of carbon dioxide (CO2) in the blood, causing oxygen (O2) to remain bound to hemoglobin in the red blood cells when it should be released to the body tissues.

Consequently, inadequate oxygen supply to the body tissues triggers signals for the heart to pump faster. In such cases, attempts to improve training performance through heart muscle strengthening alone will not be effective. To identify and address this issue, a valuable tool for measuring breathing patterns and data, such as AYO BT+, can provide critical insights.

By utilising AYO BT+, athletes can gain valuable information about their breathing patterns and identify weaknesses in their oxygen delivery process. This data allows for a more comprehensive assessment of fitness levels and training effectiveness. By incorporating breathing analysis alongside heart rate monitoring, athletes can optimise their performance and make informed adjustments to their training routines.

Recognising the integral role of breathing in assessing fitness and training effectiveness unveils a more accurate and complete picture. AYO BT+ empowers athletes to unlock their potential by providing valuable breathing data, enabling targeted improvements in oxygen delivery and overall performance.

Embrace the science of breathing and maximise your training potential with AYO BT+. Discover the transformative impact of comprehensive fitness assessments and elevate your athletic performance to new heights.

See Training Result Before the Athlete Can Feel It

With multiple breathing data measured by AYO BT+, such as:

Breath per minute
Minute ventilation
Tidal volume
Vital lung capacity
Power of breathing
Work of breathing

The coach and athlete can see minor but continued improvements from a given training program that the result can’t be felt or sensed yet. This will encourage the athlete to stick to a potentially good training program and keep the program the same.

Create a Benchmark for Key Breathing Data Among Elite Athletes to Assist Sports Training

Measuring critical breathing data shown above among elite athletes with AYO BT+ for various sports, grouped by gender, age, height, and weight, will help many athletes to use these data as a benchmark to train towards.

Combination of Heart Rate with Respiratory Rate and Volume

Since the cardiovascular and respiratory systems combine to deliver O2 to and remove CO2 from all body tissues, adding breathing data such as respiratory rate and volume will add further dimensions and depth. This will complement the heart rate in assessing an athlete’s fitness level and performance. Doing so may revolutionise the way of sports training.

With AYO BT+, elite athletes gain the advantage of harnessing their breath as a powerful tool for performance enhancement. By embracing diaphragmatic breathing as the foundation of their training, athletes can unlock their full potential and propel themselves to new levels of success in their chosen sports.

Discover the transformative power of AYO BT+ and make diaphragmatic breathing an integral part of your athletic journey. Prepare to revolutionise your performance and excel like never before.

Diaphragmatic Breathing Training in Jogging with AYO BT – Part 2

by admin | Oct 7, 2022 | Uncategorized

Continued from Diaphragmatic Breathing Training in Jogging with AYO BT – Part 1

In Part 1, we introduced training in the Default configuration which focuses on training and activating Inspiratory muscles.

In Part 2, we will introduce training in 3 optional configurations.

Training with AYO BT in Option 1 configuration – Expiratory Focus

In Option 1 configuration, the BTi in the Default configuration is fitted to the right side of the mask, and no module is fitted to the left side of the mask.

In this configuration, the BTi on the right side will independently limit the exhalation by adjusting the air opening so that, the exhaled air is restricted thus increasing the resistance to exhale.

AYO BT in this configuration will train and activate exhalatory muscles.

When properly adjusted, the training will promote the following to your breathing:

A slower and longer exhalation.
When you breathe slower and longer, you could easily breathe through your nose, and more importantly, expiratory diaphragm muscles are more engaged.
When the exhalation is slowed, depending on the exercise intensity and the BTi setting, it can create some air hunger, so even if you perform a full stroke of diaphragm movements, hyperventilation can be avoided.

Reference Training Program

1. Adjust the BTi setting to the level suitable for easy jogging and your current fitness.

As a general guide:

For advanced Nose-breather, set to Level2 to level4.
For novice Nose-breather, set around level4 to 6.

2. Jog between 15 to 25 minutes.

Exhale slowly and steadily.
Press the belly slightly feeling the pressure it works against.
At the end of the exhalation, simply relax the belly and let go of it.
This starts the inhalation.
Keep the belly relaxed until it is around the neutral position.
Without pushing it further outward, pause the breath a bit, and then time to start the slow exhalation again.
This training is meant to have a shorter inhalation and a much longer exhalation.
When finishing the exercise, keep wearing it for at least 5 minutes while doing some stretches.

Training with AYO BT in Option 2 configuration – Inspiratory + Expiratory

In Option 2 configuration, the BTi in the Default configuration is fitted to the right side of the mask, and the BTo to the left side of the mask.

In this configuration, no air will enter from the left side of the mask, and both inhalation and exhalation will go through the BTi on the right side of the mask. Therefore, by adjusting the air opening at BTi, both the inhalation and the exhalation will be restricted to the same amount, thus increasing the resistance to both inhalation and exhalation.

AYO BT in this configuration will train and activate both Inspiratory and exhalatory muscles.

When properly adjusted, the training will promote the following to your breathing:

A slower and longer inhalation and exhalation.
When you breathe slower and longer, you could easily breathe through your nose, and more importantly, both your inspiratory and expiratory diaphragm muscles are engaged.
When the breath is reduced, depending on the exercise intensity and the BTi setting, it can create some air hunger, so even if you perform a full stroke of diaphragm movements, hyperventilation can be avoided.
This training can create deep and symmetric diaphragm movement that trains both inspiratory and expiratory muscles at the same time.

Note:

No independent control for inhalation and exhalation in this configuration.

Reference Training Program

1. Adjust the BTi setting to the level suitable for easy jogging and your current fitness.

As a general guide:

For advanced Nose-breather, set to Level3 to level4.
For novice Nose-breather, set around level5 to 6.

2. Jog between 10 to 20 minutes.

Inhale and exhale slowly and steadily.
Press the belly slightly feeling the pressure it works against.
At the end of the exhalation, simply relax the belly and let go of it.
This starts the inhalation.
Keep the belly relaxed until it is around the neutral position.
Then push the belly further outward to extend the inhalation further.
Try to pause a bit at the end of the inhalation to allow time for the inhaled air to reach the lungs fully.
This training is meant to have a balanced inhalation and exhalation.
This exercise may put a higher load on the diaphragm, so listen to your body and slow down the run or even walk when the load becomes unbearable.
Alternatively, go one level up on the adjustment.
When finishing the exercise, keep wearing it for at least 5 minutes while doing some stretches.

Training with AYO BT in Option 3 configuration – Inspiratory* + Expiratory

In Option 3 configuration, one BTi is fitted to the left side of the mask, and another BTi is fitted to the right side of the mask (not included in the standard AYO BT package).

In this configuration, inspiratory air will enter from both BTi on the left side and right side of the mask, and the expiratory air will still go only through the BTi on the right side of the mask. Therefore, adjusting the air opening on the right side will independently restrict the expiratory air, while adjusting the air opening on the left side will partially adjust the inspiratory air, and the other part is affected by the adjustment at the BTi on the right side of mask.

AYO BT in this configuration will focus on training and activating the exhalatory muscles while providing some degree of control on the inspiratory muscles.

When properly adjusted, the training will promote the following to your breathing:

A slower and longer inhalation and exhalation.
When you breathe slower and longer, you could easily breathe through your nose, and more importantly, both your inspiratory and expiratory diaphragm muscles are engaged.
When the breath is reduced, depending on the exercise intensity and the BTi setting, it can create some air hunger, so even if you perform a full stroke of diaphragm movements, hyperventilation can be avoided.
This training can create deep and semi-symmetric diaphragm movement that trains both inspiratory and expiratory muscles at the same time.

Note:

Independent control for Expiration but semi-independent control for inhalation in this configuration.

Reference Training Program

1. Adjust the BTi setting to the level suitable for easy jogging and your current fitness.

As a general guide:

For advanced Nose-breather, set to Level3 to level4.
For novice Nose-breather, set around level5 to 6.

2. Jog between 10 to 20 minutes.

Inhale and exhale slowly and steadily.
Press the belly slightly feeling the pressure it works against.
At the end of the exhalation, simply relax the belly and let go of it.
This starts the inhalation.
Keep the belly relaxed until it is around the neutral position.
Then push the belly further outward to extend the inhalation further.
Try to pause a bit at the end of the inhalation to allow time for the inhaled air to reach the lungs fully.
This training is meant to have a suitable inhalation resistance while focusing on the expiratory training.
When finishing the exercise, keep wearing it for at least 5 minutes while doing some stretches.

Diaphragmatic Breathing Training for Jogging – Part 1

by admin | Oct 7, 2022 | Uncategorized

Why Diaphragmatic Breathing?

The diaphragm is one of the main breathing muscles that should be used for our breathing by default. Diaphragmatic breathing training helps utilize the lower parts of the lungs that are more efficient to transport oxygen than chest (thoracic) breathing.

Efficient breathing helps better oxygen consumption by cells and tissues in the body, thus producing better sports performance as well as promoting better general health.

However, most modern people have predominant chest breathing where the lower parts of the lungs are less used, and as a result, breathing becomes inefficient, leading to less competitiveness in sports, or chronic hyperventilation in a lifetime that compromises people’s wellbeing.

In addition, diaphragmatic breathing can also achieve efficient lymphatic drainage of abdominal organs which is beneficial for your long-term health.

Here are some more general benefits this type of breathing can bring:

It helps you relax, lowering the harmful effects of the stress hormone cortisol on your body.
It lowers your heart rate.
It helps lower your blood pressure.
It helps you cope with the symptoms of post-traumatic stress disorder (PTSD).
It improves your core muscle stability.
It improves your body’s ability to tolerate intense exercise.
It lowers your chances of injuring or wearing out your muscles.
It slows your rate of breathing so that it expends less energy.

Mastering diaphragmatic breathing has a profound impact on your sports performance or your well-being in general.

Diaphragmatic Breathing Training with AYO BT in Jogging

While there are many ways to train for diaphragmatic breathing, most require dedicated time and focus to train properly. For many people with a busy lifestyle, it may be difficult to find time regularly for doing this specific training. Further, commonly recommended training for the diaphragm requires you to lie on the floor with a book on the belly, or in a still position placing your hand on the belly. The main issue with this type of training is a lack of linkage to real-life day-to-day activities, let alone physical exercises and sports training. The good news is that, with AYO BT, one can combine this breathing training with one of the routine exercises shared by many – jogging, either as a warm-up before a serious training section, or using jogging as a cross-training / general fitness exercise.

The goal of diaphragmatic breathing is to move your belly outward to make space for the diaphragm to go downward when you inhale, and to move the belly inward for the diaphragm to move upward to squeeze out the air at the bottom of the lungs when you exhale.

However, even with nasal breathing, one could cause hyperventilation during diaphragmatic breathing, especially when practising a full stroke of deep diaphragmatic muscle movement aggressively and repetitively which could result in breathing too much air that exceeds the need for metabolic rate the jogging exercise imposes on the body leading to over-breathing, thus compromising the benefits offered from the exercise.

In order to achieve the full benefits of diaphragmatic breathing training while at the same time avoiding hyperventilation, the key is to control the air intake according to the intensity of the exercise, and this is exactly what AYO BT is designed for.

Training with AYO BT in Default configuration – Inspiratory Focus

In the default configuration, where the BTi is fitted to the left side of the mask, and the BTo to the right side of the mask, the BTi can limit the air intake by adjusting the air inlet so that, the air is restricted thus increasing the resistance to breathe.

AYO BT in this configuration will focus on training and activating Inspiratory muscles.

When properly adjusted, the training will promote the following to your breathing:

A slower and longer inhalation: if you try to breathe very hard, you wouldn’t get enough air as you would normally expect without wearing the respirator, and this is because the inhalation resistance through the small inlet at a high flow rate will be too big to breathe, thus leading you to breathe slower and longer.
When you breathe slower and longer, you could easily breathe through your nose, and more importantly, your diaphragm is more engaged.
When the air intake is reduced, depending on the exercise intensity and the BTi inlet setting, it can create some air hunger, so even if you perform a full stroke of diaphragm movements, hyperventilation can be avoided.

Diaphragmatic breathing Patterns

In comparison with Chest breathing, diaphragmatic breathing is generally slower and longer. However, it doesn’t mean that both inhalation and exhalation are equally slow and long, this is particularly true when doing certain breathing exercises.

The following training programs outline two of many possible options, and once mastered the techniques, you can make an adaptation to tailor to your specific needs and situations at ease.

Overtime with this training, you would expect the following distinctive benefits:

Be able to use the diaphragm to breathe naturally.
Stronger breathing muscles.
Less breathlessness in high-intensity exercise.
Improved breathing efficiency.
Improved stamina and fitness.

Reference Diaphragmatic Breathing Training Program


Diaphragmatic breathing pattern focusing on Inspiration timing:	Diaphragmatic breathing pattern focusing on Expiration timing:
1. Use nasal breathing only during the entire exercise.	1. Use nasal breathing only during the entire exercise.
2. Adjust the BTi Setting to the level suitable for easy jogging and your current fitness. As a general guide: For advanced Nose-breather, set to Level2 to level4. For novice Nose-breather, set around level4 to 6.	2. Adjust the Inlet Setting 1 – 2 settings above the Inspiratory timing focused training.
3. Jog between 15 to 30 minutes. As a general guide, try to breathe slower and longer during inhalation and exhalation. Try to make the Inhalation constantly in 4 running steps while 6 steps for exhalation. You may exhale quicker down to 4 steps if the jogging intensity varies, such as running up a hill, but try not to exhale shorter than 4-steps while keeping inhalation constant at 4-steps. At the start of each inhalation, try to soften the urge to breathe hard. Simply let your abs relax to utilize the changeover momentum from the end of Exhalation followed by a slow and long inhalation. You should feel a ‘dropping’ diaphragm sensation and this is a good sign of you are doing it right. From the start to 2/3 of each exhalation, relax your abs to let the air out effortlessly. At the last 1/3 of each exhalation, press the abs inward to squeeze out the remaining air in the bottom of the lungs. Try to pause a bit at the end of the inhalation to allow time for the inhaled air to reach the lungs fully. If the Setting doesn’t give you sufficient resistance, that probably means that your fitness level is higher, or the intensity is not sufficient which requires a lower Inlet Setting to further reduce the air intake until your breathing is nicely slow and long. The BTi should be adjusted to lead you to breathe slower and longer in order to breathe in enough air to sustain the training intensity, in the process your diaphragm is engaged while it cooperates naturally and accordingly to your breathing.	3. Jog between 15 to 30 minutes. As a general guide, try to breathe slower and longer during inhalation and exhalation. Try to make the Exhalation constantly in 6 running steps or longer while 2 steps for Inhalation. You may inhale longer up to 3 steps if the jogging intensity varies, such as running up a hill, but try not to inhale longer than 3-steps while keeping Exhalation constant at 6-steps or longer. At the start of each inhalation, try to soften the urge to breathe hard.. Simply let your abs relax to utilize the changeover momentum from the end of Exhalation followed by a slow and long inhalation. You should feel a ‘dropping’ diaphragm sensation and this is a good sign of you are doing it right. From the start to 2/3 of each exhalation, relax your abs to let the air out effortlessly. At the last 1/3 of each exhalation, press the abs inward to squeeze out the remaining air in the bottom of the lungs. Try to pause a bit at the end of the inhalation to allow time for the inhaled air to reach the lungs fully. If the Setting doesn’t give you sufficient resistance, that probably means that your fitness level is higher, or the intensity is not sufficient which requires a lower Inlet Setting to further reduce the air intake until your breathing is nicely slow and long. The BTi should be adjusted according to the exercise intensity so that your exhalation is maintained at 6-steps or longer, while your inhalation is maximum 3-steps or shorter.

CONTINUE TO Diaphragmatic Breathing Training in Jogging with AYO BT – Part 2

AYO BT – Why It Is an Essential Tool for Breathing Training

by admin | Sep 20, 2022 | Diaphragmatic Breathing

The problem

It may be hard to believe that most of us modern-day humans over-breathe chronically. It has been proven that chronic hyperventilation is at least in part responsible for a range of chronic diseases, such as asthma, high blood pressure, heart disease, diabetes, cancer, etc.

The causes

There are quite a number of factors that cause the vast majority of us to chronically over-breathe, including lifestyle factors, such as sedentary habits, lacking regular exercise, over-eating, and incorrect breathing patterns and habits.

Regarding lifestyle, more and more people are becoming aware of it, and with determination and discipline, a healthier active lifestyle can be achieved. However, incorrect breathing patterns and habits formed over many years may not be easy to change, especially if the patterns and habits have been consolidated by one’s every breath since a very young age!

The following are the most common unhealthy breathing patterns and habits:

Mouth breathing
Chest breathing
Fast and big breathing

CO2 – the leading factor responsible for breathlessness

It sounds very odd to many, but CO2 plays a critical role in breathing, in a sense, even more, critical than O2!

The reason we say this is that our blood is normally saturated with oxygen, and it doesn’t matter if we breathe a bit more or less than normal, the O2 saturation in the blood is hardly changed.

However, if you chronically over-breathe, the breathing nerve centre in the brain will become over-sensitive to CO2 increase, which causes breathing faster than normal, and a vicious cycle like the below will occur:

The faster you breathe → the more CO2 will be removed from the blood → and according to Bohr Effect, the less O2 will release from the red blood cells to the body tissues → the tissues thus sending the signal to the brain to breathe even faster.

This process causes breathlessness.

The Buteyko Method to breathe normally

Believe it or not, to get healthier, most modern people need breathing retraining. Buteyko Breathing is a science-based systematic breathing method to train reduced breathing and achieve normal breathing, which is well suited to prevent chronic over-breathing.

Based on Dr. Buteyko and his team’s medical research from the 1950s through to the early 2000s, plus tens of thousands of people’s positive practice of the breathing method, the following steps summarize the Buteyko Method in a simple way to work towards breathing normally and healthily:

Use the diaphragm to breathe through the nose in and out only whenever you can.
Practice reduced breathing, including breath-hold, small volume diaphragmatic inhalation, and full body relaxed long exhalation.
Practice breathing exercises involving slight air hunger.

AYO BT – A perfect tool to assist Buteyko Breathing

AYO BT breathing trainer works by controlling the air inlet to add resistance to reduce breathing, such that it makes the inhalation slow and long and activates the diaphragm that one must use to achieve normal breathing.

The following are the key points about why AYO BT is ideal for Buteyko breathing training:

Encourage and train to breathe using the diaphragm via the nose.
Easy to adjust the air resistance to reduce breathing.
Easy changeover between inspiratory and expiratory training.
Easier adaptation to higher CO2 and lower O2 – reduces breathlessness.

Tool for Breathing Training – Using AYO BT as a tool perfectly aligns with the key elements of Buteyko Breathing Method.

Using AYO BT over a period of time will train you to use your diaphragm naturally, allowing you to practice reduced breathing and adapt to higher CO2 without having to focus on your breathing all the time, thus making it easier to normalize your breathing.

In addition, the unique modular design of AYO BT allows a future upgrade to more advanced AYO BT+ which provides breathing data measurement with state-of-the-art technology.

Pursed-lip Breathing Replacement with AYO BT

by admin | Sep 5, 2022 | Uncategorized

What is Pursed-lip Breathing?

Pursed-lip breathing is a breathing technique where the lips are pursed to form a smaller airpath like a short straw which creates breathing resistance and back pressure during exhalation. This created back pressure helps keep the collapsed airways open so that carbon dioxide that’s trapped in the lungs can get out. This technique is particularly useful for COPD which usually causes the airway to collapse, and it is a common breathing technique as a part of pulmonary rehabilitation programs.

Pursed-lip Breathing

What is the common procedure to perform Pursed-lip Breathing?

Breathe in through the nose using the diaphragm during inhalation.
Purse the lips as if to whistle during exhalation.
Slowly exhale through pursed lips. Some resistance should be felt.
It should take about twice as long to exhale as it does to inhale.

What is the shortcoming of the Pursed-lip Breathing?

The key shortcoming of pursed-lip breathing is the repeated process of alternating from nose breathing to mouth breathing, where it requires constant effort on the part of the patient to control the pursed-lip which makes it a bit hard to adapt correctly and consistently over an extended time. Therefore, pursed-lip Breathing is not ideal if the exercise is long which may be needed for some COPD patients.

Normal Configuration of AYO BT Breathing Trainer

In the normal configuration, AYO BT consists of an Inhalation module BTi on the left side of the mask, and an Exhalation module BTo on the right side of the mask. In the configuration shown below, it trains inspiratory muscles when the air inlet in the BTi is adjusted small enough to create inhalation resistance while BTo provides an Exhalation valve to ease exhalation. In this configuration, the inspiratory resistance can be adjusted independently:

How to Use AYO BT to Improve Pursed-lip Breathing – Option 1

For COPD breathing training, where an increased exhalation resistance and pressure are needed, the normal BTo module can be replaced by another BTi module as shown below, so that an adjustable air outlet can be achieved to vary the back pressure of the lung during exhalation:

In this configuration, the BTi on the right side will independently limit the exhalation by adjusting the air opening so that, the exhaled air is restricted thus increasing the resistance to exhale.

AYO BT in this configuration will train and activate exhalatory muscles.

How to Use AYO BT to Improve Pursed-lip Breathing – Option 2

For applications requiring symmetric adjustment of inhalation and exhalation, one can fit the BTi module on the Right side of the mask, and fit the BTo on the Left side of the mask as shown below:

Note: In this configuration, the inspiratory and expiratory resistance are adjusted at the same time and no independent adjustment is possible.

In summary, when configured and adjusted properly, AYO BT can be used as an improved method for Pursed-lip Breathing. In particular, it can be configured:

to train both the inspiratory and expiratory breathing muscles.
to provide exhalation resistance/back pressure for a long period without the control effort from the patient as for pursed-lip breathing.
to breathe in the entire exercise through the nose only, which also helps normalize breathing by using the diaphragm.